A case-control study of risk factors for fetal and early neonatal deaths in a tertiary hospital in Kenya.

Faith Yego,Paul Nyongesa,Jennifer Stewart Williams,Julie Byles,Catherine D’Este

doi:10.1186/s12884-014-0389-8

Abstract

BackgroundIt is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. Fetal and neonatal mortality is a sensitive indicator of maternal health in society. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya.MethodsThis was a case-control study. Cases were fetal and early neonatal deaths (n = 200). The controls were infants born alive immediately preceding and following the cases (n = 400). Bivariate comparisons and multiple logistic regression analyses were undertaken.ResultsThe odds of having 0-1 antenatal visits relative to 2-3 visits were higher for cases than controls (Adjusted Odds Ratio (AOR) = 4.5; 95% CI: 1.2-16.7; p = 0.03)). There were lower odds among cases of having a doctor rather than a midwife as a birth attendant (AOR = 0.2; 95% CI: 0.1-0.6; p < 0.01). The odds of mothers having Premature Rupture of Membranes (AOR = 4.1; 95% CI: 1.4-12.1; p = 0.01), haemorrhage (AOR = 4.8; 95% CI: 1.1-21.9; p = 0.04) and dystocia (AOR = 3.6; 95% CI: 1.2-10.9; p = 0.02) were higher for the cases compared with the controls. The odds of gestational age less than 37 weeks (AOR = 7.0; 95% CI 2.4-20.4) and above 42 weeks (AOR = 16.2; 95% CI 2.8-92.3) compared to 37-42 weeks, were higher for cases relative to controls (p < 0.01). Cases had higher odds of being born with congenital malformations (AOR = 6.3; 95% CI: 1.2-31.6; p = 0.04) and with Apgar scores of below six at five minutes (AOR = 26.4; 95% CI: 6.1-113.8; p < 0.001).ConclusionInterventions that focus on educating mothers on antenatal attendance, screening, monitoring and management of maternal conditions during the antenatal period should be strengthened. Doctor attendance at each birth and for emergency admissions is important to ensure early neonatal survival and avert potential risk factors for mortality.

Highlights

It is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally
Data were separately stored in the Moi Teaching Referral Hospital (MTRH) neonatal and maternal records
This study examined risk factors associated with fetal and early neonatal mortality at MTRH

Summary

Introduction

It is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya. Neonatal death is defined as newborn death occurring within the first four weeks after birth [1]. In Sub-Saharan Africa, for example, the proportion of neonatal deaths among under five deaths. Neonatal death is defined as all deaths of live-born infants occurring on or before the first seven days of life. There is evidence that the highest numbers of early neonatal deaths in Sub-Saharan Africa are due to infections [10,11]

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